title: [Indications of mesh in surgical treatment of pelvic organ prolapse by vaginal route: expert consensus from the French College of Gynecologists and Obstetricians (CNGOF)].
abstract: OBJECTIVE
  To determine the indications and contraindications concerning prosthetic surgery by vaginal route for pelvic organ prolapse.
  
  
  METHODS
  Literature review and rating of proposals using a formal consensus method.
  
  
  RESULTS
  Before surgery for genital prolapse, the patient should be counselled about the different existing techniques (abdominal and vaginal surgery with and without mesh), the reasons why the surgeon offered her the placement of a synthetic mesh and also other nonsurgical treatments (pelvic floor rehabilitation and pessary). The intervention must be preceded by an assessment of bothersome pelvic, urinary, digestive and sexual symptoms. For the surgical treatment of cystocele, the use of a synthetic mesh placed by vaginal route is not recommended routinely. It should be discussed on a case by case considering the risk/benefit ratio. In patients presenting with cystocele recurrence, the placement of a synthetic mesh is a reasonable option, in order to reduce the risk of cystocele recurrence. With the exception of a few situations (rectocele recurrence), the placement of a synthetic mesh is not recommended as first-line therapy for the surgical treatment of rectocele by vaginal route. In case of uterine or vaginal vault prolapse, repositioning the vaginal vault or uterus using synthetic mesh arms is not recommended as first-line surgical therapy.
  
  
  CONCLUSIONS
  Surgeons should implement established preventive recommendations that may reduce the risk of complications.
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France. Electronic address: xavier.deffieux@abc.aphp.fr.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.forename: L
authors.initials: L
authors.lastname: Sentilhes
authors.forename: D
authors.initials: D
authors.lastname: Savary
authors.forename: V
authors.initials: V
authors.lastname: Letouzey
authors.forename: M
authors.initials: M
authors.lastname: Marcelli
authors.forename: P
authors.initials: P
authors.lastname: Mares
authors.forename: F
authors.initials: F
authors.lastname: Pierre
mesh_terms: D032921:Consensus; D052858:Cystocele / Q000601:surgery; D005260:Female; D005602:France; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006176:Gynecology; D006801:Humans; D009774:Obstetrics; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D020047:Rectocele / Q000601:surgery; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects*
keywords: Consensus d’experts; Cystocele; Cystocèle; Expert consensus; Genital prolapse; Guidelines; Mesh; Pelvic organ prolapse; Prolapsus; Prothèse; Recommandations; Rectocele; Rectocèle; Vaginal surgery; Vaginal vault; Voie vaginale